Provider Demographics
NPI:1235385725
Name:HAMPTON, THERA LYNN (OT)
Entity Type:Individual
Prefix:MISS
First Name:THERA
Middle Name:LYNN
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 LADY FERN ST.
Mailing Address - Street 2:
Mailing Address - City:PLUMAS LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95961
Mailing Address - Country:US
Mailing Address - Phone:510-709-5673
Mailing Address - Fax:
Practice Address - Street 1:1345 LADY FERN ST.
Practice Address - Street 2:
Practice Address - City:PLUMAS LAKE
Practice Address - State:CA
Practice Address - Zip Code:95961
Practice Address - Country:US
Practice Address - Phone:510-709-5673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 9635174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist